TableĀ 3

Reviewer commentary on care judged short of best practice

Overall care score 3Reviewer commentsComment type (Pos or Neg)/category
Admission phase score 4pH 7.436
Good history taken of COPD symptoms and normal functional status,Pos/C
alternative diagnosis of PE and CCF not excluded in a patient with risk factors for bothNeg/B
Clinical cardiovascular exam not thorough (no mention of JVP, pedal oedema, chest expansion, sputum characteristics)Neg/C
Initial management phase score 4Patient received appropriate treatment for COPD (ie, steroids, antibiotics and nebulizers),Pos/C
however the CXR result was never recorded ?looked atNeg/B
Later management phase score 2Although the patient was recorded to be clinically improving 2/7 post admission and team were considering early discharge, his ABG was not improving and patient's SOB+tachypnoea attributed to anxiety, pt (patient) gradually deterioratedNeg/B
Patient changed to inhalers too soonNeg/C
Seen appropriately by respiratory team, frusemide (furosemide) and aminophylline infusion appropriately suggestedPos/C
Nursing staff inappropriately withheld oral medications as they thought he was nil by mouthNeg/C
Developed severe type 2 respiratory failure but no decision on resus status made until patient very unwell. This needed to be made by on call teamNeg/B
Earlier referral to ITU and I.v aminophylline may have changed outcomeNeg/C
Good chest physio(therapy) inputPos/C
Overall care score 3Patient appropriately treated initially with nebs, antibiotics and steroidsPos/C
however patient's treatment plan not escalated until he was in severe type 2 respiratory failureNeg/B
NIV/ITU not considered in this patient ?why-he had no other co-morbidities and no previous hospital admissionsNeg/C
Resus decision made inappropriately by on call team when patient very unwellNeg/C
  • ABG, arterial blood gases; CCF, congestive cardiac failure; COPD, chronic obstructive pulmonary disease; CXR, chest radiograph; ITU, intensive therapy unit; I.v, intravenous; JVP, jugular venous pressure; nebs, nebuliser; NIV, non-invasive intubation; PE, pulmonary embolus; pt, patient; resus, resuscitation; SOB, shortness of breath.